The present study is based on information received from 8795 women who had 11062 children age 12-36 months at the time of survey. Fifty two percent are male and 48 percent are female children. Majority children are from rural area and Hindu by religion. More than one-third children are from other backward castes followed by upper caste children. Rest of them is from scheduled tribe and scheduled caste. Children belonging to other/ upper castes are 24 percent. More than two-thirds mothers (69 percent) and about two-fifths fathers of these children are illiterate. More than half the mothers (54 percent) belong to the middle age group (25-34 years). More than two-thirds children live in kuchha houses.

The analysis of vaccine specific data indicates that BCG, three doses of DPT, three doses of Polio and Measles vaccine have been received by 71, 62, 71, and 57 percent children respectively. Although DPT and polio vaccinations are given at the same time as part of the routine immunization programme, the coverage rates are higher for Polio than DPT, probably because of the Pulse Polio Programme. Less than one-third children in Madhya Pradesh have received Vitamin A doses and only 5 percent are given Iron Folic Acid tablets or syrup.

It is observed that 47 percent children have received complete vaccination against all the six preventable diseases. Thirteen percent did not receive any vaccination. Among 45 districts in Madhya Pradesh the percentage of children who received complete immunization ranging between 75-100, 50-74, 25-49, 0-24 are 3, 21,17, and 4 respectively.

Considerable regional variations are observed in the utilization of immunization services in Madhya Pradesh. Complete immunization of children is found highest in South Western and lowest in Vindhyan regionthe coverage of all the different vaccines is particularly low inVindhyan region.Inter-district variations in the proportion of children who have been fully vaccinated have been found to be high. The highest coverage is seen in Balaghat (90 percent) and lowest in Panna (11 percent). Other poor coverage districts are seen as Morena, Jhabua and Tikamgarh districts.

The complete vaccination coverage of children is substantially higher in urban areas than in rural areas. The coverage is seen relatively poor among Hindus as compared to Muslims and children belonging to other religions. A poor coverage is seen among scheduled tribe children as compared to scheduled caste, other/upper caste children. A strong positive relationship between mother’s education and children’s vaccination coverage is observed. Mother’s higher level of literacy (high school pass) facilitates child vaccination and at the same time illiteracy inhibits the child’s immunization process. The complete vaccination coverage is higher for children residing in pucca houses or having access to piped water as compared to their counterparts residing in kuchha houses or having access to surface water only. This indicates that the socio-economic status of the mothers influence the immunization seeking behavior for their child.

Children who have not received a single vaccination, is highest in Vindhyan region followed by Northern and Malwa regions. The proportion of no immunization is comparatively low in Chhattisgarh and South Central regions. Among the districts the proportion of children having received no immunization at all is highest in Jhabua district followed by Satna and lowest in Balaghat district (1 percent). Moreover, there are nearly one-third districts in M.P. where 50 percent or more children have received partial immunization only.

The main source of vaccination is seen as either a government hospital or health worker. Majority of children have received immunization at government hospital CHC/PHC, sub-centre, or through an ANM. Children who received their vaccinations from the private sources are seen relatively more in urban areas or among children whose mothers have completed high school and above.

It is surprising to note that nearly half the mothers were not given any advise for vaccination for their children. It is observed that for DPT and Polio vaccines a little more than half (51-54 percent) and in case of Measles vaccine less than half of the mothers (44 percent) were advised by a doctor or health worker to give the vaccine to their children. Mothers from Vindhya and Northern regions are very poorly advised regarding immunization of their child as compared to mothers from South Western and Chhattisgarh.

Reasons cited by mothers for not providing complete immunization or the required doses of DPT, and Polio are mainly seen as“not aware of the need for immunization”, “not aware of all three doses”, “mother too busy”, “vaccine not available”, and “ANM absent” etc. These reasons were highlighted more in Malwa, Vindhya, and Northern regions.

Some reasons given by mothers like ‘not aware of the need for immunization or not aware of all three doses’, ‘mother too busy’ indicate that more focused and intensive publicity at the local or village level is required. Providing accurate information about the doses at repeated intervals needs to be given to remove doubts and superstitions among illiterate mothers. Fathers of children from the rural background need to be sensitized and motivated to take their child for immunization in case the mother is busy. Their involvement and participation in their children’s health programme could ensure better results. Vindhya and Northern regions need special inputs in terms of skilled manpower, more IEC activities and better services in remote and outreach areas because of their inaccessibility. Better service delivery mechanisms like mobile van facilities and outreach session schemes have to be provided by the state to improve the status of immunization. Regular supply of vaccine has to be ensured at the CHC level and the ANM’s presence at the site on the day fixed for vaccination is necessary.

The Madhya Pradesh government aims to achieve total immunization of 70 percent by 2005 and 90 percent by 2009. For improvement in the immunization programme illiterate women, tribal and inaccessible areas, and poor performing districts have to be specially targeted. To achieve this goal there should be a decentralized strategy for different targeted groups.